Best Practice - What Is It?Best practice is the method or technique that is most practical and valid in delivering a desired outcome. Ok, so what does this mean in real terms? What we're really saying here is that evidence based practice is a techniques or process that delivers efficiency and effectiveness. The double ee's lead, ultimately, to another e: the holy grail of outcomes - high efficacy. Let's look at those terms carefully. Efficiency is about performing a task with a minimum of time and effort, using expert knowledge and skill. Effectiveness is all about competently delivering the desired or expected result. One of the things I like most about the speech pathology profession is its insistence that all practitioners perform under the direction of research based methods. Yet, current speech-language pathology methods are not set in concrete. The process is something that, by necessity, continues to evolve and grow. New research is continually being published, as researchers discover new and better methods of understanding and treating language disorders. A speech-language pathologist's role is to keep up to date with new research, deliver evidence-based practice, and also refine and expand their clinical skills. Some of those clinical skills I hope to share with you as part of the language resources packages.
Evidence Based Language Research
There has been a large amount of research completed over the past 30 years concerning language disorder and best practice treatment options. And language disorder's effects on the school-age students has been well documented. However, not all research studies have the same efficacy and level of control. Let me explain... The role of research is to try and establish cause and effect. There is a pecking order, or degree of scale; it starts with studies considered to have low efficacy, and progresses all the way up to studies which are considered to have the highest efficacy. At the lower end of the research scale is anecdotal evidence. Anecdotal evidence cannot really be considered evidence of a treatment effect. This can be a concern, because we may have initiated a truly clever and inspired therapy. And we may record that the therapy helped children to learn a new language skill. For example, say I have created a whiz-bang computer program that teaches figurative language, such as idioms and metaphor. I test the program on 5 children - the treatment group - and over a period of 6 months all of the students in that group improve their metaphorical knowledge abilities. Whoa, that must mean my computer program works!!! Right? Not so fast... There's a problem here. I didn't establish a control group, or non-treatment group, to compare the results of the treatment group against. How do I know with certainty that my treatment worked? I don't. The students' improvement could have been the result of natural maturation on their parts, or a host of other factors. Anecdotal evidence helps to personalize a therapy outcome, so we may attach enormous emotional weight and significance on a given result, which can be a problem. It's difficult to accept that our treatment may not have been the important factor in the students' improved performance. In our example, it's possible my computer program caused the positive outcome in the treatment group. But if I haven't controlled all the variables, then I can't prove my therapy worked, or would work for other students in other situations. The above scenario may seem a little far fetched, but it's not really. It's actually quite common. There are reading and literacy programs that are perhaps not best practice, and have little better than anecdotal evidence to support their claims. They often don't have the gold-plated standard of research that 'proves' their programs have high efficacy, but they are often marketed as being highly successful. Which leads us onto the prince of research standards... Best Practice - Randomized, Double-Blind Controlled Study
A controlled clinical trial is a study which tests a particular treatment (i.e. idioms-metaphor program) on two or more distinct groups of students. One group (the treatment group) receives the therapy, the other group (the control group) receives no treatment, or receives an alternate treatment. So, with our example of the idioms-metaphor program, if our treatment group improves their knowledge of idioms, and the control group records no improvement, we could be more confident in stating that our idioms-metaphor program had a treatment effect; in short - that it works. For more detailed information about controlled studies and best practice please follow this link. Return from best practice to speechlanguage-resources home page
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